If you have had a heart attack, bypass surgery, a stent, a heart-valve procedure, or you live with stable angina or stable heart failure, Georgia Medicare covers cardiac rehabilitation under Part B. This guide explains who qualifies, how many sessions Medicare pays for, what you will owe out of pocket in Georgia, and how to get started.

In This Guide

Do You Qualify for Georgia Medicare Cardiac Rehabilitation?

Georgia Medicare cardiac rehabilitation is a Part B benefit, not a Georgia Medicaid program, so any Georgian with Original Medicare or a Medicare Advantage plan can use it after a qualifying heart event. Medicare covers cardiac rehab, both standard and intensive, if you have had at least one of these seven conditions:

  1. A heart attack (acute myocardial infarction) in the last 12 months. The 12-month clock runs from the date of the heart attack, so it is worth starting rehab soon after your cardiologist clears you.
  2. Coronary artery bypass graft (CABG) surgery.
  3. Current stable angina (chest pain that has been steady in how often and how hard it hits).
  4. A heart valve repair or replacement, whether an open-surgical or transcatheter procedure.
  5. A coronary angioplasty (PTCA) or coronary stenting, including a drug-eluting stent placed after a heart attack or for stable angina.
  6. A heart or heart-lung transplant.
  7. Stable, chronic heart failure. For intensive cardiac rehab, this means a left ventricular ejection fraction of 35 percent or less and New York Heart Association (NYHA) class II to IV symptoms despite at least 6 weeks of optimal heart-failure therapy.

If any of these describes you, you meet Medicare's medical eligibility. Your cardiologist or surgeon confirms the qualifying condition in your record and writes the referral.

How Cardiac Rehab Works: Sessions, Setting, and Components

Cardiac rehabilitation is a monitored program of exercise, education, and counseling designed to help you recover from a heart event and lower your risk of the next one. Each session runs about an hour and typically combines supervised aerobic exercise (treadmill, stationary bike, or similar), strength work, and teaching on heart-healthy habits, medications, and managing risk factors like blood pressure, cholesterol, and diabetes. Continuous heart-rhythm (ECG) monitoring is common in the early sessions and for higher-risk patients.

Medicare lets you receive cardiac rehab in a doctor's office or a hospital outpatient department (including a critical access hospital), which matters for cost, as the next section explains.

For standard cardiac rehab, Medicare covers up to two 1-hour sessions per day, up to 36 sessions over a period of up to 36 weeks. Up to 36 additional sessions may be allowed, but the allowance is narrower than "more if it helps": CMS billing guidance permits the second block only where a significant intercurrent illness or comorbidity occurred during the first 36 sessions and the program's exit criteria have not been met. Most Georgia beneficiaries attend three sessions a week for about 12 weeks.

Standard vs. Intensive Cardiac Rehabilitation (ICR)

Intensive cardiac rehabilitation (ICR) is a more concentrated version of the same benefit, authorized under Section 1861(eee)(4) of federal Medicare law and governed by national coverage rules for approved ICR programs. ICR covers up to 72 one-hour sessions, up to 6 per day, over a period of up to 18 weeks (double the session volume of standard cardiac rehab in half the calendar window), and it must be delivered through a specific program model that Medicare has approved as meeting the ICR standard. Where standard cardiac rehab is exercise-focused, ICR programs build comprehensive lifestyle change into the core curriculum.

The three CMS-approved ICR programs

Only three CMS-approved ICR programs exist nationally, and a Georgia hospital cannot invent its own "intensive" program and bill it as ICR. It must license and deliver one of these three:

  • The Pritikin Program (CMS-approved effective August 12, 2010) emphasizes plant-forward nutrition, exercise, stress management, and behavioral medicine.
  • Dr. Ornish's Program for Reversing Heart Disease (CMS-approved effective August 12, 2010) is built on Dr. Dean Ornish's protocols for reversing coronary disease through lifestyle change, with four equally weighted parts: nutrition (low-fat, plant-based eating), fitness, stress management (yoga, meditation, breathing), and group support.
  • The Benson-Henry Institute Cardiac Wellness Program (CMS-approved effective May 6, 2014), developed from Dr. Herbert Benson's work on the mind-body "relaxation response," emphasizes stress management and mind-body practice integrated with exercise and nutrition.

All three build nutrition, stress management, and behavioral change into the core curriculum rather than treating them as optional add-ons. To win approval, each had to show in peer-reviewed published research that it did at least one of three things for its patients: positively affected the progression of coronary heart disease, reduced the need for coronary bypass surgery, or reduced the need for percutaneous coronary interventions. That evidence bar is what separates ICR from standard exercise-based cardiac rehab.

How the 72-session schedule works

Each ICR session is one hour, up to 6 can be delivered in a single day, and no more than 72 sessions may be furnished over the 18-week window from your start date. The six-sessions-a-day allowance supports concentrated multi-day schedules, which can cut the travel burden for a rural Georgia beneficiary who would otherwise drive a long way three times a week. Once you reach 72 sessions or the end of the 18-week window, the statutory allowance for that course is used up, and most people move to self-directed maintenance, such as a home routine, a gym membership, or a support group. If you later have a separate qualifying event, do not assume a second full course is automatic: the statute sets the 72-session, 18-week allowance but does not spell out how a later episode is counted, so ask the program and your Medicare Administrative Contractor before you enroll again.

CMS's national coverage determination describes ICR as "a physician-supervised program that furnishes cardiac rehabilitation services more frequently and often in a more rigorous manner" than the standard benefit. In practice that means ICR runs through programs with physician staffing, usually hospital-based outpatient departments, rather than free-standing fitness or community sites.

How ICR is billed

ICR is billed under HCPCS codes G0422 and G0423, while standard cardiac rehab uses CPT codes 93797 and 93798. In practice you and your cardiologist choose one pathway for a given recovery: ICR for the accelerated, lifestyle-medicine approach, or standard cardiac rehab for the 36-session, exercise-focused one. Because a full ICR course runs up to 72 sessions rather than 36, the cumulative 20 percent coinsurance across a complete course is roughly double that of a standard course at the same per-session rate.

The medical eligibility is the same seven conditions either way. ICR sites are far less common than standard cardiac rehab, and availability in Georgia shifts as programs license and de-license, so call the program to confirm it is running and currently ICR-licensed before you count on it. If you have several risk factors you want to attack hard, ask your cardiologist whether an ICR program is worth traveling for; if a standard program near home is what is available, it delivers the core benefit.

What Does Georgia Medicare Cardiac Rehabilitation Cost?

What you pay depends on where you get rehab and what supplemental coverage you carry. The mechanics are the same across Georgia.

Original Medicare, doctor's office. After you meet the annual Part B deductible ($283 in 2026), you pay 20 percent of the Medicare-approved amount for each session.,

Original Medicare, hospital outpatient department. Most Georgia cardiac rehab runs through a hospital outpatient program, which is paid under the Outpatient Prospective Payment System. There you pay the hospital a copayment for each session after the Part B deductible. At a regular hospital, the copayment for any one outpatient service cannot exceed the Part A inpatient hospital deductible ($1,736 in 2026). Two limits on that ceiling matter here: it applies per service, so several outpatient services can total more than $1,736, and it does not hold at a critical access hospital, where Medicare says your outpatient copayment may be higher and may exceed the Part A deductible. If your rehab runs through a rural critical access hospital, ask the billing office what one session will cost you before you enroll.,

With a Medigap policy. A Medigap Plan G policy gives the same benefits as Plan F except that it does not cover the annual Part B deductible, so it picks up your Part B cost-sharing for rehab in full and a whole course can cost you nothing beyond that deductible. Medigap Plan N pays 100 percent of the cost of Part B services too, with two carve-outs: a copayment of up to $20 for some office visits, and up to $50 for an emergency-room visit that does not lead to admission. Note the bound on that first carve-out. It is written for office visits, and a hospital outpatient department is not an office visit, so whether the $20 lands on your rehab sessions depends on how the program bills them. Ask the program which way it bills and ask your carrier how it applies the Plan N copay before you budget for 36 of them.

With Medicare Advantage. Every Medicare Advantage plan must cover the medically necessary Part A and Part B services Original Medicare covers, and cardiac rehab is one of them. (Hospice is the exception to that rule; it stays with Original Medicare even if you are in an Advantage plan.) Your cost-sharing is set by the plan, usually a flat per-session copay, and every plan caps your in-network out-of-pocket spending on Part A and Part B services for the year, federally limited to $9,250 in 2026, with many plans setting a lower cap. That cap does not cover Part D drug spending. Check your plan's copay and whether it requires prior authorization or an in-network cardiac rehab site.

What It Looks Like in Practice

Where to Get Cardiac Rehab in Georgia

Cardiac rehab is widely available across Georgia through the major health systems, and most cardiologists refer directly into their own system's program:

  • Metro Atlanta: Emory Healthcare (Emory University Hospital, Emory Saint Joseph's, Emory Midtown, and other campuses), Piedmont Healthcare (Piedmont Atlanta and its statewide network), Wellstar Health System (Kennestone, Cobb, Douglas, and more), and Grady Health System.
  • North Georgia: Northeast Georgia Medical Center in Gainesville and Braselton.
  • Coastal and East Georgia: Memorial Health University Medical Center in Savannah, historically a notable intensive cardiac rehab site, and Wellstar MCG Health (the former Augusta University Medical Center) in Augusta.
  • Central and Southwest Georgia: Atrium Health Navicent in Macon, Piedmont Columbus Regional, and Phoebe Putney Memorial Hospital in Albany.

Smaller rural and critical access hospitals across Georgia have variable cardiac rehab availability, so if the nearest program is far, ask your cardiologist about the closest option and whether any hybrid or home-supported sessions are offered.

How to Start Cardiac Rehab in Georgia

1
Step 1

Get the referral from your cardiologist or surgeon

Cardiac rehab requires a physician referral that documents your qualifying condition. Ask about it before you leave the hospital or at your first follow-up visit, when eligibility is easiest to establish.

2
Step 2

Confirm your qualifying condition and timing

Make sure the referral names the qualifying event, and if it was a heart attack, start within the 12-month window. Optimal timing is generally a few weeks after the event, once your care team clears you.

3
Step 3

Choose a program and confirm it is in network

Pick a hospital or office program near you. If you have Medicare Advantage, confirm the site is in your plan's network and ask whether prior authorization is required.

4
Step 4

Check what you will owe

Ask whether the program bills as a hospital outpatient department or a doctor's office, and confirm how your Medigap or Medicare Advantage coverage handles the coinsurance or copay. If the program sits at a critical access hospital, ask specifically what one session's copayment is, because the usual per-service ceiling does not apply there.

5
Step 5

Enroll and commit to the full course

Complete the intake evaluation, then attend consistently, typically three sessions a week. If a significant illness or comorbidity interrupts you partway through the first 36 sessions, tell your physician, because that is the circumstance under which a second block of 36 sessions can be allowed.

Common Mistakes Georgia Families Make

  • Not knowing cardiac rehab is a covered Medicare benefit. Awareness is the biggest barrier. If you have had any of the seven qualifying conditions, ask your doctor about cardiac rehab; do not wait to be offered it.
  • Missing the 12-month heart-attack window. If a heart attack is your only qualifying condition, enroll within 12 months or you may lose eligibility.
  • Misreading the rule on a second block of 36 sessions. Standard cardiac rehab can extend past 36 sessions, but not on general medical necessity: the extra 36 are allowed where a significant intercurrent illness or comorbidity occurred during the first 36 sessions and the exit criteria have not been met. Ask your physician whether your record fits that test rather than assuming an extension is there for the asking.
  • Assuming you know how your Medigap plan handles rehab. Plan G covers your Part B cost-sharing except the deductible. Plan N covers it too, except for copays on some office visits and some ER visits, and whether a rehab session counts as an office visit depends on how the program bills. Ask before you enroll, not after.
  • Assuming Medicare Advantage will not cover it. Every Medicare Advantage plan must cover cardiac rehab; the cost-sharing just differs, and it may require prior authorization.
  • Not appealing a denial. A denial is not the end of it. Medicare has a five-level appeals process, and a Medicare Advantage denial starts with the plan itself, which must automatically forward an adverse reconsideration to an independent review entity.

Frequently Asked Questions

Who qualifies for Medicare cardiac rehabilitation?

Medicare covers cardiac rehab if you have had at least one of seven conditions: a heart attack in the last 12 months, coronary artery bypass surgery, current stable angina, a heart valve repair or replacement, a coronary angioplasty or stent, a heart or heart-lung transplant, or stable chronic heart failure (for intensive cardiac rehab, a left ventricular ejection fraction of 35 percent or less with NYHA class II to IV symptoms on optimal therapy for at least 6 weeks).

How many cardiac rehab sessions does Medicare cover?

Standard cardiac rehab covers up to two 1-hour sessions per day, up to 36 sessions over up to 36 weeks. A second block of up to 36 sessions may be allowed, but only where a significant intercurrent illness or comorbidity occurred during the first 36 sessions and the exit criteria have not been met. Intensive cardiac rehab covers up to 72 sessions, up to 6 per day, over up to 18 weeks.

What does cardiac rehab cost in Georgia?

In a doctor's office you pay 20 percent of the Medicare-approved amount after the Part B deductible ($283 in 2026). In a hospital outpatient department you pay the hospital a per-session copayment instead. A Medigap Plan G policy covers that Part B cost-sharing in full, leaving you only the deductible; Plan N covers it too, apart from a copay of up to $20 on some office visits, so ask your program how it bills before assuming that copay applies to your sessions.,

What is the difference between standard and intensive cardiac rehab?

Standard cardiac rehab runs up to 36 sessions over up to 36 weeks. Intensive cardiac rehab (ICR) is more concentrated, up to 72 sessions over up to 18 weeks, delivered through a Medicare-approved program: the Pritikin Program, Dr. Ornish's Program for Reversing Heart Disease, or the Benson-Henry Institute Cardiac Wellness Program.

Does Medicare Advantage cover cardiac rehab?

Yes. Medicare Advantage plans must cover the medically necessary Part A and Part B services Original Medicare covers, and cardiac rehab is one of them (hospice is the exception, and stays with Original Medicare). Cost-sharing is set by the plan (often a per-session copay), and every plan caps your in-network out-of-pocket costs on Part A and Part B services for the year, federally limited to $9,250 in 2026. That cap does not apply to Part D drug spending.

Can I appeal if my cardiac rehab is denied?

Yes. Medicare has a five-level appeals process. For Original Medicare, the first level is a review by your Medicare Administrative Contractor, requested within 120 days of the initial claim decision on your Medicare Summary Notice.

Where can I find a cardiac rehab program in Georgia?

Start with your cardiologist, who can refer you into their health system's program, and use the AACVPR directory below to find certified programs near you. Major Georgia systems, including Emory, Piedmont, Wellstar, Northeast Georgia, Memorial Health, and Phoebe Putney, all run cardiac rehab. Georgia SHIP, the state's free Medicare counseling program, is the place to take the coverage questions rather than the provider search: its certified counselors help with plan choices, Medicare Summary Notices, medical bills, claims, and appeals, at no cost and without selling insurance.

Where to Get Help in Georgia

Medicare Coverage rules, costs, and plan questions, 24 hours a day. 1-800-633-4227https://www.medicare.gov/talk-to-someone medicare.gov
Georgia SHIP (GeorgiaCares) Free, unbiased Medicare counseling from certified volunteers, Monday to Friday, 8 a.m. to 5 p.m.: plan choices, Medicare Summary Notices, medical bills, claims, and appeals. Counselors do not sell insurance. 1-866-552-4464, option 4https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship aging.georgia.gov/georgia-ship
AACVPR Program Directory Find a certified cardiac rehab program near you. 1-312-321-5146 aacvpr.org
American Heart Association Patient education on recovery, risk factors, and heart-healthy living. 1-800-242-8721 heart.org

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Find personalized help navigating Georgia Medicare cardiac rehabilitation at brevy.com.

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